【作者】 庞猛；

【导师】 冯加纯；

【作者基本信息】 吉林大学 ， 神经病学， 2009， 博士

【摘要】 本研究旨在探讨颈脑动脉粥样硬化性狭窄血管形态因素与脑梗死的关系,分析颈脑动脉粥样硬化性狭窄支架成形术和单纯药物治疗的有效性及安全性。研究对象为2004年4月至2008年4月间在我院经脑血管造影检查发现单纯颈内动脉系统狭窄>30%的180例患者。我们分析了与脑梗死相关的血管形态因素,并根据是否行支架成形术将符合入选标准的160例患者分为手术组(58例)、丙丁酚治疗组(50例)和对照组(52例)。监测三组血流动力学改变,观察治疗后30天、12个月总的血管事件发生率。结果发现,有5个对脑梗死可能具有促进作用的血管形态因素。进一步干预治疗后30天总的血管事件发生率手术组显著低于对照组(3.4%比17.3%,P<0.05),12个月两组仍存在明显差异(13.6%比38.0%,P<0.05)。治疗后30天总的血管事件发生率丙丁酚治疗组与对照组差异无统计学意义(20.0%比17.3%,P>0.05),但12个月两组差异显著(18.0%比38.0%,P<0.05)。手术组共计发生并发症35例,但对患者预后有明显不良影响的主要并发症仅有3例(5.4%)。通过对颈脑动脉粥样硬化性狭窄的血管形态因素分析,以及160例患者手术治疗和药物治疗效果分析,我们得出结论:与脑梗死相关的血管形态因素有近深穿支开口部病变、重度狭窄病变、不稳定斑块病变、偏心性病变、狭窄远端灌注异常等;支架成形术可在短期内降低卒中发生率,安全性可接受;随访12个月,丙丁酚治疗也可减少了血管事件发生,且与支架成形术无显著差异。更多还原

【Abstract】 Objective:The purpose of brain atherosclerotic stenosis of ischemic stroke is an important pathogenic factor in carotid artery stenosis> 70% of the patients, the annual stroke rate was as high as 13%. Active treatment of cerebral artery stroke to reduce mortality and disability are important. At present, the main means of commonly used treatment, including stent implantation and drug therapy alone, according to the characteristics of patients with lesions to choose their own appropriate forms of treatment is becoming the focus of attention. The purpose of this study was to explore the brain carotid atherosclerotic stenosis morphology of vascular factors and cerebral infarction, and stent-assisted angioplasty for treatment and drug efficacy and safety of comparative research, to provide a basis for clinical treatment.Methods:From April 2004 to April 2008, I have completed the entire Section 428 cases of cerebral angiography. Which the internal carotid artery system, 260 cases of stenosis of lesions (60.7%), vertebrobasilar system, 224 cases of stenosis of lesions (52.3%), while 56 cases involved (13.1%). The first part of this study for which a simple system of internal carotid artery stenosis> 30% of the patients, a total of 180 cases. According to the results of imaging, there will be likely to cause cerebral infarction and cerebral vascular shape factors were analyzed and found that the Department of the deep perforating branches of open lesions, severe stenosis, and unstable plaque lesions, and eccentric lesions, a narrow distal perfusion abnormalities, such as the five factors on the cerebral infarction were significantly affected, suggesting that cerebral infarction may be the contributing factor.Results:According to the first part of the results of a study by cerebral angiography proved to be a simple system of internal carotid artery stenosis> 30% of patients with 180 cases, which meet the standards of 160 cases selected into the second part of study patients.Sexual division of intent to take, including 58 cases of stent-assisted angioplasty for patients, as surgery group, 50 cases of patients receiving probucol therapy, as probucol treatment group, 50 cases of other patients because of economic reasons stenting failed to trip operation, nor the use of probucol and other lipid-lowering drugs, only to receive conventional drug treatment, we also carried out follow-up, as the control group. Monitoring system, three sets of carotid hemodynamic changes and to observe the 30 days after treatment, 12 months, the incidence of vascular events, stroke and death in severe cases to the end.A total of 58 cases of 66 patients had lesions CCAS stenting, in which a stent placed in 53 patients, two stents in 5 patients. 32 extracranial carotid artery disease in 12 non-expansion, 20 pre-expansion, 3 for expansion of the latter. Intracranial lesions of the use of balloon-expandable stent, a shape in general, not to pre-expansion (Wingspan, except self-expanding stent). Filter protection devices were used in 31 cases, 13 cases of postoperative emboli filter with debris visible to the naked eye. Restenosis rate from an average preoperative to 79.6±10.5% after an average of 12.8±10.1% (p <0.01), vessel diameter changes before and after surgery significantly (2.18±1.25mm, 3.9±0.3mm, p <0.01). Within 30 days after treatment, vascular surgery group events (including TIA, stroke, myocardial infarction, vascular causes of death) 2 cases (2 / 58), in which place of the small fry in the same side, ipsilateral major stroke in 1 case, no TIA and fatal occurrence of stroke and death. Vascular events occurred in the control group a total of 9 cases (9 / 52), including the following: ipsilateral TIA2 cases, the performance of a physical inability to have sex, clinical examination of brain CT made no new infarct, ipsilateral in place of the small fry, ipsilateral major stroke all three cases (of which 1 patient died of myocardial infarction), fatal stroke and death in 1 case. Group of vascular surgery the incidence (3.4%) lower than the control group (17.3%), with statistically significant differences (P<0.05). Probucol treatment group occurred in 10 cases of vascular events, in which case TIA2 ipsilateral, ipsilateral and the place of the small fry in the three cases of stroke, fatal stroke and 1 died, Probucol treatment group the total incidence of vascular events of 20.0% compared with the control group There was no significant difference. Group of vascular surgery the incidence (3.4%) lower than probucol treatment group (20.0%), the difference was statistically significant. 12 months after treatment, the surgery group occurred in a total of eight cases of vascular events (13.6%), including the following: ipsilateral TIA2 cases, two cases of ipsilateral stroke, non-three cases of ipsilateral stroke, fatal stroke and death in 1 case. The control group a total of 19 cases of vascular events (38.0%), including the following: ipsilateral TIA 8 cases, 5 cases of ipsilateral stroke, non-three cases of ipsilateral stroke, three cases of fatal stroke. The two groups overall incidence of vascular events significantly different (13.6% vs 38.0%, P <0.05). Probucol treatment group a total of 9 cases of vascular events, including the following: ipsilateral TIA, ipsilateral stroke, non-three cases of ipsilateral stroke each, compared with the control group were statistically significant differences in surgical treatment group and the probucol group of The incidence of vascular events compared with no statistical difference.Operation-related complications occurred in 35 cases, including over-reperfusion syndrome, acute thrombosis, vascular rupture, one had cerebral vasospasm, carotid sinus response, such as hematoma puncture point. One of the prognosis of patients with a significant adverse impact on three cases of major complications were caused by over-perfusion one cases of intracranial hemorrhage, brain blood vessel rupture, 1 case of acute stent thrombosis in 1 case. A total of 32 cases of secondary complications: response to carotid sinus in 23 cases, five cases of cerebral vasospasm, 3 cases of hematoma puncture point, one cases of femoral artery dissection, but were quickly improved the prognosis of patients with no significant impact. Total incidence of major complications of 5.4%.Conclusions:CCAS of the form factors of vascular disease, as well as 160 cases of surgical treatment of lesions CCAS and drug treatment effect analysis, we draw the following conclusions: with cerebral vascular patterns associated factors include the following: Near the deep perforating branches of the Department of openings lesions, severe stenosis and unstable plaque lesions, eccentric lesions, distal perfusion abnormalities such as stenosis; stenting can be reduced in the short term incidence of stroke, security acceptable; follow-up of 12 months, although probucol treatment can reduce the vascular events, but stenting compared with no significant difference.更多还原